Self-disinfecting High Touch Surfaces in Practical Use

Infection Control Today, Volume 26, Issue 9

Can antimicrobial products withstand day-to-day real-life wear and tear if the antimicrobial material is part of the product and not only a coating? A study in Switzerland tried to find out.

Coatings of antimicrobial products on high touch surfaces do not last long in real life situations, but with multiresistant pathogens on the rise, something must be done. In Switzerland, a study was conducted on devices with the antimicrobial product built in.

To discuss this idea, Infection Control Today® (ICT®)spoke to Andreas Widmer, MD, MS, president of the National Center for Infection Control, University of Basel in Basel, Switzerland, lead author of the study; and Frédéric Loyrion, sales manager at Sanitized, also in Switzerland, about the study that Widmer and his team conducted using a Sanitized product to combat multiresistant pathogens on high contact surfaces. The study was presented at the Clean Hospitals Day Conference held on October 20, 2022, in Geneva, Switzerland.

ICT®: Dr. Widmer, would tell us the key points of the study?

Andreas Widmer, MD, MS AW: Yeah, I think we all know that the environmental contamination of multiresistant pathogens is a major issue. It has been part of the COVID-19 pandemic where contact also is an issue. And after SARS 1, my colleague [W. H.] Seto from Hong Kong initialized that all elevators public elevators have to be cleaned every hour, 24/7. In our area, we couldn't afford the human resources to clean it repetitively. Knowing that recontamination occurs even in the hospital within 4 to 6 hours after disinfecting the room. One of the [answers] would be self-disinfecting areas and devices, which we already know from intravascular catheter wherever used very successfully and other medical devices. But in the environment, it was more difficult because you have a coating which has been used, then with the physical aberration and say, more or less abuse of the hospital staff with carts and devices, this coating falls apart, and the effect of self-disinfection is gone.

We already did some tests, and it didn't work more than 2 to 4 weeks. And then this coating was not effective anymore. There was a need for [a] new device or new technology, and then we came up to Sanitized, which produces a product that's in the device. It's not a coating; it's in the device. Even if you have kind of physical attacks by our health care workers, the injured part is still effective. And that's the reason why our federal [Swiss] government subsidized the study, to make sure that this product is not only working in the laboratory, but also in a daily practice in a university hospital setting.

ICT®: What was the goal of this research?

AW: The goal of the research was to identify, in particular, multiresistant pathogens. In the past, a lot of studies were done with just bacterial load. And we have good bacteria and bad bacteria. That brought us that we don't want to eliminate all bacteria in the hospital. You don’t want to get rid of all of those bad bacteria. In the past, it was very difficult because if you have just a swab from the surface, any swabs would cost you about $400-500 to identify all pathogens. Now we have a new technology available [within the last] couple years that allows you to do it at a much lower cost. And that's the reason why we were able to identify all bacteria and separate good bacteria [from] the bad bacteria, and the basic study results that we could [get] with this product, you have a significant difference between non-Sanitized surfaces versus Sanitized surfaces, and, in particular, a significant reduction of the multiresistant pathogens.

ICT®: What are the specific takeaways for infection preventionists and environmental service professionals?

AW: We, at least for new building, we should allow to have some products that have antimicrobial efficacy and effectiveness not on the surface but within the product in (I would say these high touch) surfaces where repetitive cleaning is physically not possible or for financial perspective not feasible. If you have an automatic cleaning, and this particular is for vancomycin resistant Enterococcus, that really helped the alternative which is also an add on is using ultraviolet (UV) light that also disinfects the surfaces because we know from this study but also from other UVC studies, that even if you have almost perfect cleaning, you have residual multiresistant bacteria. So the physical cleaning, even if it's done under supervision, is not perfect. And for certain areas, I would say for transplant units, multiresistant pathogens are an issue, for operating rooms (ORs), everywhere where people have high touch surfaces, including elevator knobs. [Sanitized] is such a product would be an add on which, if it's financially accepted and doesn't need replacement every week, is the way to go in future.

That was in the preface of this study that the identified bacteria is on public areas, like airports, train stations. They realize that bad bacteria, pathogenic bacteria are more prevalent in this area than in hospitals.

ICT®: What was the contribution of Sanitized within this study?

Frédéric Loyrion: Sanitized made the initial tests in the lab in order to choose the suitable PVC film composition, the formulation for running the study. And the film was provided by one of our customers located in France, Hexis, who is manufacturing self-adhesive films. We then concert in the Professor Whitmer and Professor Frei [another author, Reno Frei, MD, Division of Infectious Diseases & Hospital Epidemiology, University of Basel Hospitals & Clinics, Basel, Switzerland], we have a preliminary results and providing them the films for running the study in their hospital. That was the main goal of Sanitized, providing the right formulation, and then providing the right film for the study.

It looks quite simple, but it was not. Then putting this material safely on the screen or on the toilet seat that is physically not damaging. This was quite challenging, and the support we got was excellent. So that's the big advantage to have onsite test because in the lab, you will just have to control an active compound, but there's no physical damage. You don't have a crazy patient who does something completely wrong. You don't have less-than-perfect motivated cleaning person who scrapes on this film. This is real life. And that's the beauty of this study that it not only made it to the lab, but it made it past the clinical tests very well, which was really a surprise to us.

ICT®: Why is Sanitized focusing on the health sector at this point.

FL: By the way, antimicrobial surfaces will never replace regular cleaning or disinfection protocols; however, it may close the gap which is left between cleaning cycle, and we are convinced at Sanitized that antimicrobial surfaces will play an important role in the future of hygiene management in health care. And, therefore, as experts in this field, we want to contribute to this important topic. We do have already a lot of our customers providing solutions, and Hexis is one of them. But we do have a lot of others providing antimicrobial treated surfaces to the hospital. However, this is done usually on a local basis. And we would expect increasing the awareness of such hygienic surfaces to the world community, and that's also the reason why Sanitized decided to adhere to the Clean Hospital project providing here with the long-term experience on integrated hygienic function to surfaces.

ICT®: Dr. Whitmer, do you have anything final to say?

AW: The question is always implementation; we have a lot of knowledge. But somebody has to think about if in the construction of new hospitals’ renovation, that people think about it, and we now have cleaning, we have UV light, which is very expensive and needs additional workload. So, to make it into the hospital is the society's are marked in the perfect situation to convince our hospital administration. And if they don't pay for it, or they don't want it, we are stuck, even if the science is well supported [by] all the data. So that's something that you really need people from marketing, not only for this compound. It’s a long story when 20 years ago, we just had a meeting with CDC and many experts in the field that 20 years ago, hand washing in the United States was standard of care. It took almost 20 years to convince people to do hand hygiene with an alcoholic compound. And Didier [Pittet, PhD], my colleague and friend, he dedicated his life for it. So we need people who provide science, but we also need people to convince politicians, administrators, the hospital administration to put the effort into including products that prevent common colonization of bacteria with on surfaces that are , called high touch surfaces.

ICT®: Mr. Loyrion, do you have any final thoughts?

FW: No, I guess the professor has said everything. I guess I'm perfectly share his point of view anyway. So we need to make the things moving on, and we have to discuss also with politicians and so on, in order to give the option to the hospital to move forwards and having hygienic surfaces wherever necesssary.

ICT®: Our sole goal for all of us—the 3 of us and every environmental hygienist, every infection preventionist--we're all there to save lives. But trying to get individuals to follow the protocols is not always easy. But that's a whole other topic. Thank you very much, gentlemen.